Establishment of diagnostic significance of high-signal intensity on T2 weight MRI in temporomandibular joint disorders

为了阐明高信号强度的意义，进行了临床和实验研究（关节积液;临床研究采用T2加权MRI对颞下颌关节紊乱病（TMD）患者进行T2加权成像，检测患者血清总蛋白和促炎细胞因子（IL-1β、IL-6、IL-8、TNF-α）及其受体以及关节镜下获得的滑膜组织的组织学和免疫组织化学评价。根据高信号区的体积将这些样本与JE等级（0-3）进行比较。关节镜检查结果（滑膜炎、粘连、退行性改变;评分0-10分）与JE分级进行比较，结果表明，只有关节镜下滑膜炎的程度与JE有显著相关性。关节液中总蛋白、IL-6、IL-8浓度与乙脑发病呈正相关。组织学上，滑膜组织中滑膜炎的程度与JE在3项中的2项（滑膜衬里细胞层和炎性细胞浸润）中有显著相关性。为探讨下颌骨前体肥大的解剖学因素，对下颌骨前体肥大患者行正颌外科手术前后的MRI进行对比研究。结果提示，关节囊内炎尤其是滑膜炎与关节内JE阳性有密切关系。JE可能反映了蛋白质和细胞因子上调并释放到关节液中。关节间隙增大可能是JE发生的解剖学因素。JE可能意味着关节内的炎症反应（滑膜炎），这可能具有重要的诊断价值。

Clinical and experimental studies were undertaken in order to elucidate the significance of high signal intensity (joint effusion ; JE) on T2 weighted MRI of the temporomandibular joint disorders (TMD).Clinical research was measurement of total protein and pro-inflammatory cytokines ( IL-1β, IL-6, IL-8, TNF-α) and their receptors in synovial fluid as well as histological and immunohistochemical evaluation of the synovial tissue obtained arthroscopically. These samples were compared with JE grade (0-3) according to the volume of high signal area. The arthroscopic findings (synovitis, adhesion, degenerative chage ; scored 0-10) were also compared with JE grades.The results showed that only the degree of synovitis detected arthroscopically had significant correlation with JE. The concentration levels total protein, IL-6 and IL-8 in synovial fluid had positive correlations with JE. Histologically, the degree of synovitis in synovial tissue showed significant relationship with JE in 2 items (synovial lining cell layer and inflammatory cell infiltration) of 3 items. To investigate the anatomical factor of JE, the pre-and post-operative MRIs were compared in orthognathic surgry underwent for mandibular progenia patients. The positive JE were depicted in joints with more movement of the condyle than less movement.These results suggest that JE in TMD (internal derangements) were closely relative with intra-capsular inflammation, especially synovitis. JE might reflect the protein and cytokines up-regulated and released into the synovial fluid. The increased joint space may contribute JE development as anatomical factor. JE probably mean the inflammatory reaction in the joint (synovitis) which might be significant diagnostic value.